THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 10

Application for Enrolment

[See sub-rule (1) of rule 17]

02 If it is an application for amendment of certificate of enrolment, state your

03 Name of the Applicant

05. Father's Name/ Husband's Name:

06. Name of the transport business:

07. Address of the Head / Main Office inWest Bengal:

11. Address and Telephone No. of all Branches Offices within West Bengal.

First Branch:

Second Branch:

12. If the transporter is a Limited Co., Number of the Certificate of Registration issued by Registrar of Companies:

13. Details of Bank Account:

First Bank:

Address

Second Bank:

Address

Third Bank:

Address

14. Registration Number (if any) under the West Bengal State Tax on Professions, Trades, Callings and Employments Act, 1979:

15. PAN/TAN Number of the firm/Company under the Income Tax Act, 1961 (if any):

16. Certificate of Enlistment issued by the Municipal/Local Body.

a) Number of the Certificate

17. Date of commencement of transport business in West Bengal:

I,......................................................do hereby declare that the above statements are true to the best of my knowledge and belief.

Signature...........................................

Date..............................

Status...................................

*Please use separate sheet wherever space is inadequate.